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What's striking about the president's pirouette on the ACA, and about Democratic disarray in the face of the renewed GOP assault in the House, is the absence of any open discourse on the underlying ethics of health care.


I've heard just a few commentators say, and rather gingerly, "Ummm, if the young and healthy people don't participate it kind of defeats the idea of how insurance works. Ummm, it's like the kids need to pay a little more so other people can have coverage that's affordable. Ummm, and maybe the president should be talking about this??"

Yes, he should be talking about it.

Universal health care coverage, which is what this law was supposed to achieve, is redistributive by its nature. And that's a good thing. It's the only way 30 million uninsured are going to have their health attended to as a basic human right.

It's bad enough that the president has been silent about the huge number of low income people of color who are being altogether stiffed in states that won't expand Medicaid coverage. It's bad enough that, in a little-discussed provision of the ACA, hospitals that serve disproportionate numbers of the urban poor are losing their subsidies. But for Obama not to stand his ground and say that the cheap, low-level policies that many healthy people now have should be cancelled for the sake of the common good: that's just inexcusable.

On the other hand, he's not getting a lot of help from his Democratic "friends" on this one, and for the same reason: They likewise don't know how to speak ethically.

Thus, Obama special friend Bill Clinton:

"I personally believe, even if it takes a change in the law, the president should honor the commitment the federal government made to those people and let them keep what they've got."

Thus, Dianne Feinstein (co-sponsoring Democratic Senator Mary Landrieu's "let 'em out" pitch for permanently exempting the young and healthy):

"Too many Americans are struggling to make ends meet.We must ensure that in our effort to reform the health care system, we do not allow unintended consequences to go unaddressed.”

Thus, Landrieu herself:

"People should be able to keep their plans if they want to."

The best that Nancy Pelosi, the primary organizer of House Democrats' loyal opposition to the Fred Upton bill, could do on Sunday's Meet the Press:

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"If you had your plan before the enactment of the law in 2010, there is nothing in the law says you have to [change it] . "

And Stenny Hoyer, Pelosi's Democratic Whip in the House:

“We knew that there would be some policies that would not qualify and therefore people would be required to get more extensive coverage.”

I leave it to you to judge how much ethical content you detect in the comments of these key Democrats. The only comment informed by a sense of the common good came from the Socialist who caucuses with the Democrats, Vermont's Bernie Sanders:

“I am a strong advocate of a Medicare-for-all single-payer program.”

Yes, Obama should apologize for misleading purchasers of cheap policies by insisting that if they like their current coverage, they can keep it. He needs to take his licks on that.

But the right answer is not to cave on the fundamental principle of shared risk. The right answer is to say, "Yes, I spoke too broadly about keeping what you have. I was referring to employer plans when I said that. But here is why we must still insist that everyone buy approved levels of coverage through the exchanges. Unless everyone participates, we can't make it work for those at greater risk."

Franklin Roosevelt wasn't the least bit preachy, but when he spoke people always heard and felt the underlying moral basis for his policies. Obama, a self-proclaimed convert to liberal Christianity, can't seem to weave a moral narrative to save his life.

Oh, and one more thing: This episode should be a wake-up call to all those who have spent tons of money trying to inject some faithiness into Democratic politics—these efforts are obviously not working.

Yes, Dems do call out the House troglodytes on the grounds of their "callousness" or "cynicism" or what have you. But as we see from the comments above, there's no real ethical substratum in any of the celebrity Dems, let alone among Dems who are deserting Obama completely and running with the haters.


We may never see a faith-rooted moral discourse in our public life, given the badly decayed state of our civil religion. Meanwhile, let's dispense with the smoke-and-mirrors simulacrum that various faithy "operatives" in DC have spent almost ten years and how many millions trying to conjure.

Peter Laarman
Religion Dispatches

Monday, 18 November 2013